EP2225563B1 - Automated enumeration and characterization of circulating melanoma cells in blood - Google Patents

Automated enumeration and characterization of circulating melanoma cells in blood Download PDF

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Publication number
EP2225563B1
EP2225563B1 EP08855440.7A EP08855440A EP2225563B1 EP 2225563 B1 EP2225563 B1 EP 2225563B1 EP 08855440 A EP08855440 A EP 08855440A EP 2225563 B1 EP2225563 B1 EP 2225563B1
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cells
circulating
melanoma
melanoma cells
blood
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German (de)
English (en)
French (fr)
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EP2225563A1 (en
EP2225563A4 (en
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Mark Carle Connelly
Galla Chandra Rao
Leon Terstappen
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Janssen Diagnostics LLC
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Janssen Diagnostics LLC
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    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
    • G01N33/53—Immunoassay; Biospecific binding assay; Materials therefor
    • G01N33/574—Immunoassay; Biospecific binding assay; Materials therefor for cancer
    • G01N33/57407—Specifically defined cancers
    • G01N33/5743—Specifically defined cancers of skin, e.g. melanoma
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
    • G01N33/53—Immunoassay; Biospecific binding assay; Materials therefor
    • G01N33/574—Immunoassay; Biospecific binding assay; Materials therefor for cancer
    • G01N33/57484—Immunoassay; Biospecific binding assay; Materials therefor for cancer involving compounds serving as markers for tumor, cancer, neoplasia, e.g. cellular determinants, receptors, heat shock/stress proteins, A-protein, oligosaccharides, metabolites
    • G01N33/57488—Immunoassay; Biospecific binding assay; Materials therefor for cancer involving compounds serving as markers for tumor, cancer, neoplasia, e.g. cellular determinants, receptors, heat shock/stress proteins, A-protein, oligosaccharides, metabolites involving compounds identifable in body fluids
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2333/00—Assays involving biological materials from specific organisms or of a specific nature
    • G01N2333/435—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans
    • G01N2333/705—Assays involving receptors, cell surface antigens or cell surface determinants
    • G01N2333/70589—CD45
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2333/00—Assays involving biological materials from specific organisms or of a specific nature
    • G01N2333/435—Assays involving biological materials from specific organisms or of a specific nature from animals; from humans
    • G01N2333/705—Assays involving receptors, cell surface antigens or cell surface determinants
    • G01N2333/70596—Molecules with a "CD"-designation not provided for elsewhere in G01N2333/705

Definitions

  • the invention relates generally to monitoring and assessing disease progression in cancer patients, based on the presence of morphologically intact circulating melanoma cells (CMC's) in blood. More specifically, methods, reagents and apparatus are described for assessing circulating melanoma cells in patients. Circulating melanoma cells are determined by highly sensitive methodologies established for isolating and imaging 1 or 2 circulating tumor cells in approximately 5 to 50 ml of peripheral blood. The level of the tumor cell number and an increase in tumor cell number provides a means to monitor patients with metastatic melanoma.
  • CMC's morphologically intact circulating melanoma cells
  • Treatment of advanced melanoma is complicated by its heterogeneous histopathology and changes in make-up that accumulates during tumor progression.
  • the enumeration and characterization of circulating tumor cells in patients with either metastatic breast or colorectal cancer has been shown to provide independent prognostic and predictive information that is clinically significant and can be used to monitor patient management.
  • Circulating tumor cells have been shown to be a critical link between primary cancer, a disease stage at which cure is possible, and metastatic disease, which continues to be the leading cause of death for most malignancies.
  • Clinical studies have shown that CTC's are a powerful prognostic and predictive biomarker in metastatic breast cancer, and similar findings have been reported in prostate cancer and colorectal cancer. These data show that CTC's are representative of the underlying biology driving metastatic cancer and suggest that further cellular and molecular analyses of these cells can reveal new insights into molecular regulation of metastasis and response to therapy.
  • metastasis can be considered the conclusive event in the natural progression of cancer.
  • the ability to metastasize is a property that uniquely characterizes a malignant tumor.
  • HER-2/neu results in decreased response to hormone therapy, and is a significant prognostic factor in predicting responses to hormone receptor-positive metastatic breast cancer.
  • methods have been described to monitor therapy or assess risks based on elevated levels ( US 5,876,712 ).
  • the base levels during remission, or even in healthy normals are relatively high and may overlap with concentrations found in patients, thus requiring multiple testing and monitoring to establish patient-dependent baseline and cut-off levels.
  • PSA levels in serum have proven to be useful in early detection.
  • the PSA test has improved detection of prostate cancer at an early stage when it is best treated.
  • An alternative approach incorporates immunomagnetic separation technology and provides greater sensitivity and specificity in the unequivocal detection of intact circulating cancer cells.
  • This simple and sensitive diagnostic tool as described ( US6,365,362 ; US6,551,843 ; US6,623,982 ; US6,620,627 ; US6,645,731 ; WO 02/077604 ; WO03/065042 ; WO 03/019141 ; and Ulmer A, Schmidt-Kittler O, Fischer J, Ellwanger U, Rassner G, Riethmüller G, Fierlbeck G, Klein CA. Immunomagnetic enrichment, genomic characterization, and prognostic impact of circulating melanoma cells. Clin Cancer Res, 10:531-537, 2004 ) is used in the present invention to provide a preclinical animal model to enumerate CTC's.
  • a blood sample from a cancer patient ( WO 03/018757 ) is incubated with magnetic beads, coated with antibodies directed against an epithelial cell surface antigen as for example EpCAM.
  • an epithelial cell surface antigen as for example EpCAM.
  • the magnetically labeled cells are then isolated using a magnetic separator.
  • the immunomagnetically enriched fraction is further processed for downstream immunocytochemical analysis or image cytometry, for example, in the CellTracks ® System (Veridex LLC, NJ).
  • the magnetic fraction can also be used for downstream immunocytochemical analysis, RT-PCR, PCR, FISH, flowcytometry, or other types of image cytometry.
  • the CellTracks® System utilizes immunomagnetic selection and separation to highly enrich and concentrate any epithelial cells present in whole blood samples.
  • the captured cells are detectably labeled with a leukocyte specific marker and with one or more tumor cell specific fluorescent monoclonal antibodies to allow identification and enumeration of the captured CTC's as well as unequivocal instrumental or visual differentiation from contaminating non-target cells.
  • This assay allows tumor cell detection even in the early stages of low tumor mass.
  • the embodiment of the present invention is not limited to the CellTracks® System.
  • the present invention provides an automated method as defined in claim 1 for isolating enriching, and analyzing circulating melanoma cells (CMC's) in the blood of patients with melanoma, incorporating clinical analysis tools such as the CellTracks® System, and is based upon the absolute number, change, or combinations of both of circulating epithelial cells in patients with metastatic cancer.
  • the system immunomagnetically concentrates epithelial cells, fluorescently labels the cells, identifies and quantifies CMC's for positive enumeration in melanoma.
  • Figure 1 CellTracks® fluorescent analysis profile used to confirm objects captured as human tumor cells.
  • Check marks signify a positive tumor cell based on the composite image.
  • Composite images are derived from the positive selection for Epithelial Cell Marker (EC-PE) and for the nuclear dye (NADYE).
  • EC-PE Epithelial Cell Marker
  • NADYE nuclear dye
  • a negative selection is also needed for the leukocyte marker (L-APC) and for control (CNTL).
  • one method for collecting circulating tumor cells combines immunomagnetic enrichment technology, immunofluorescent labeling technology with an appropriate analytical platform after initial blood draw.
  • the associated test has been shown to have the sensitivity and specificity to detect these rare cells in a sample of whole blood and to investigate their role in the clinical course of the disease in malignant tumors of epithelial origin. From a sample of whole blood, rare cells are detected with a sensitivity and specificity to allow them to be collected and used in modeling disease progression in an animal model.
  • Circulating tumor cells have been shown to exist in the blood in detectable amounts. This created a tool to investigate the significance of cells of epithelial origin in the peripheral circulation of cancer patients ( Racila E., Euhus D., Weiss A.J., Rao C., McConnell J., Terstappen L.W.M.M. and Uhr J.W., Detection and characterization of carcinoma cells in the blood, Proc. Natl. Acad. Sci. USA, 95:4589-4594 (1998 )). This study demonstrated that these blood-borne cells might have a significant role in the pathophysiology of cancer. Having a detection sensitivity of 1 epithelial cell per 5 ml of patient blood, the assay incorporated immunomagnetic sample enrichment and fluorescent monoclonal antibody staining followed by flowcytometry for a rapid and sensitive analysis of a sample.
  • the CellSearchTM System (Veridex LLC, NJ) previously has been used to isolate and enumerate circulating epithelial tumor cells from human blood samples. This is an automated system that enriches for epithelial cells using antibodies to epithelial-cell adhesion molecule coupled to magnetic beads. Isolated cells then are stained with the fluorescent nucleic acid dye 4,2-diamidino-2-phenylindole dihydrochloride (DAPI) to identify nucleated cells. Recovered cells subsequently are stained with fluorescently labeled monoclonal antibodies to CD45 (APC channel) and cytokeratin 8, 18, 19 (PE channel) to distinguish epithelial cells from leukocytes. Nucleated epithelial cells then are quantified as circulating tumor cells. There is an additional fluorescence channel for FITC that is not part of the standard CellSearchTM assay and may be used for further characterization of tumor cells.
  • DAPI 4,2-diamidino-2-phenylindole dihydrochloride
  • the assay was further configured to an image cytometric analysis such that the immunomagnetically enriched sample is analyzed by the CellTracks® System.
  • image cytometric analysis such that the immunomagnetically enriched sample is analyzed by the CellTracks® System.
  • This is a fluorescence-based microscope image analysis system, which in contrast with flowcytometric analysis permits the visualization of events and the assessment of morphologic features to further identify objects.
  • CD146 (also know as MUC18, MCAM, Mel-CAM and S-Endo-1) is a transmembrane glycoprotein possessing a limited tissue distribution, including endothelial cells, smooth muscle cells, follicular dendritic cells, melanoma cells, and a subpopulation of activated T lymphocytes.
  • Ki-67 also know as antigen identified by monoclonal antibody Ki-67 or MK167 is a cellular marker for proliferation and is associated with cell proliferation. During interphase, the Ki-67 antigen can be detected within the cell nucleus, whereas in mitosis most of the protein is relocated to the surface of the chromosomes. Ki-67 protein is present during all active phases of the cell cycle (G1, S, G2, and mitosis), but is absent in resting cells (Go). It is generally used as a marker to determine the growth fraction of a cell population.
  • the CellTracks® AutoPrep® System and CellTracks® Analyzer II were used to fully automate the capture and detection of CMCs.
  • CMC assay magnetic particles conjugated to antibody specific for the melanoma cell adhesion molecule (CD146) are used to capture melanoma cells from 7.5 mL of blood.
  • CD146 melanoma cell adhesion molecule
  • the enriched CMC's are then stained with the nucleic acid dye DAPI, and a monoclonal antibody conjugated to PE specific for the High Molecular Weight Melanoma Associated Antigen.
  • the assay also contains APC conjugated monoclonal antibodies to CD45 and CD34 to exclude co-purified leukocytes and circulating endothelial cells, respectively.
  • FITC labeled anti-Ki67 was added to determine the proportion of CMC in cell cycle (G1, S, G2 or M phase) while in circulation.
  • the enriched and stained CMC's were magnetically mounted within a CellTracks cartridge and scanned using the CellTracks Analyzer II. Individual images of cells were presented to the operator for review, and scored as CMC's, based on fluorescence and cell morphology.
  • the CMC assay consistently recovered >65% of the melanoma cells from the cell line SK-MEL28 when spiked into 7.5 mL of blood from healthy donors. The assay was linear over the tested range of from 1 to 1200 melanoma cells/7.5ml(r 2 of 0.999, slope 0.74, intercept 6.8).
  • This automated CMC assay is a useful monitoring device for patients with metastatic melanoma, assessing prognosis, or possibly as a tool for evaluating biomarkers, targets, and potential treatments in this difficult and aggressive disease.
  • the CellTracks® System refers to an automated fluorescence microscopic system for automated enumeration of isolated cells from blood.
  • the system contains an integrated computer controlled fluorescence microscope and automated stage with a magnetic yoke assembly that will hold a disposable sample cartridge.
  • the magnetic yoke is designed to enable ferrofluid-labeled candidate tumor cells within the sample chamber to be magnetically localized to the upper viewing surface of the sample cartridge for microscopic viewing.
  • Software presents suspect cancer cells, labeled with antibodies to cytokeratin and having epithelial origin, to the operator for final selection..
  • the invention uses immunomagentic enrichment for isolating tumor cells from a biological sample.
  • Epithelial cell-specific magnetic particles are added and incubated for 20 minutes. After magnetic separation, the cells bound to the immunomagnetic-linked antibodies are magnetically held at the wall of the tube. Unbound sample is then aspirated and an isotonic solution is added to resuspend the sample.
  • a nucleic acid dye, monoclonal antibodies to cytokeratin (a marker of epithelial cells) and CD 45 (a broad-spectrum leukocyte marker) are incubated with the sample.
  • the unbound fraction is again aspirated and the bound and labeled cells are resuspended in 0.2 ml of an isotonic solution.
  • the sample is suspended in a cell presentation chamber and placed in a magnetic device whose field orients the magnetically labeled cells for fluorescence microscopic examination in the CellTracks® System.
  • Cells are identified automatically in the CellTracks® System and candidate circulating tumor cells presented to the operator for checklist enumeration.
  • An enumeration checklist consists of predetermined morphologic criteria constituting a complete cell.
  • Cytokeratin positive cells are isolated by immunomagnetic enrichment using a 7.5 ml sample of whole blood from humans. Epithelial cell-specific immunomagnetic fluid is added and incubated for 20 minutes. After magnetic separation for 20 minutes, the cells bound to the immunomagnetic-linked antibodies are magnetically held at the wall of the tube. Unbound sample is then aspirated and an isotonic solution is added to resuspend the sample. A nucleic acid dye, monoclonal antibodies to cytokeratin (a marker of epithelial cells) and CD 45 (a broad-spectrum leukocyte marker) are incubated with the sample for 15 minutes.
  • the unbound fraction is again aspirated and the bound and labeled cells are resuspended in 0.2 ml of an isotonic solution.
  • the sample is suspended in a cell presentation chamber and placed in a magnetic device whose field orients the magnetically labeled cells for fluorescence microscopic examination in the CellTracks® System.
  • Cells are identified automatically in the CellTracks® System; control cells are enumerated by the system, whereas the candidate circulating tumor cells are presented to the operator for enumeration using a checklist as shown in Figure 1 .

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EP08855440.7A 2007-11-27 2008-10-20 Automated enumeration and characterization of circulating melanoma cells in blood Active EP2225563B1 (en)

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US434507P 2007-11-27 2007-11-27
PCT/US2008/080436 WO2009070392A1 (en) 2007-11-27 2008-10-20 Automated enumeration and characterization of circulating melanoma cells in blood

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EP2225563A4 EP2225563A4 (en) 2011-11-16
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JP (1) JP5479355B2 (ko)
KR (1) KR101604649B1 (ko)
CN (1) CN101878429B (ko)
BR (1) BRPI0819854B1 (ko)
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HK (2) HK1148068A1 (ko)
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KR20100101109A (ko) 2010-09-16
MX2010005811A (es) 2010-06-09
CA2706442A1 (en) 2009-06-04
DK2225563T3 (en) 2015-02-09
IL205864A0 (en) 2010-11-30
EP2225563A1 (en) 2010-09-08
BRPI0819854A2 (pt) 2015-06-16
KR101604649B1 (ko) 2016-03-18
US20090136946A1 (en) 2009-05-28
HK1148348A1 (en) 2011-09-02
HK1148068A1 (en) 2011-08-26
JP2011505012A (ja) 2011-02-17
CN101878429B (zh) 2015-05-20
JP5479355B2 (ja) 2014-04-23
WO2009070392A1 (en) 2009-06-04
IL205864A (en) 2016-12-29
BRPI0819854B1 (pt) 2019-06-04
EP2225563A4 (en) 2011-11-16
CA2706442C (en) 2017-07-11

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